Brought to you by:

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With contributions from:

John Perryman, Charles Cappell,

Physicians for a National Health Program (PNHP)

Our current system, the history of how we got here, and how to move forward

Racial Inequities

in U.S. Healthcare:

This presentation is meant for educational purposes.

ISPC is a 501(c)3 organization and, as such, does not endorse or oppose any candidates for public office.

Our Current

System

How Did

We Get Here?

Single Payer for Healthcare

Equity

Our Current System

Our current system doesn't work!

• Exorbitant costs
• Lack of accessible care
• Administrative waste
• Poor health outcomes

All compounded by racial inequities

Deferring Care Due to Cost

• Percent of adult ages 19-64 who reported any of the following cost-related access problems:
• Had a medical problem but did not visit doctor or clinic
• Did not fill a prescription
• Skipped recommended test, treatment, or follow-up
• Did not get specialist care

Percent of adult ages 19-64 who reported any of the following cost-related access problems:

• 67% of those filing bankruptcies attributed healthcare costs as a major factor

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• 70-80% of those had private insurance when they became ill

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• 57% of people who lost their homes to foreclosure identified medical debt as a major cause

More bad news…

Different insurers reimburse at different levels

Meanwhile, community and public hospitals have far more uninsured and Medicaid patients.

Hospital try to optimize their 'payer mix' by looking for ways to attract wealthier, private insurance patients.

• Medicaid pays the lowest
• Medicare pays more
• Private insurance pays the most

Hospital Hierarchy

Hospital Cost Per Day

Community and Rural Hospitals are Closing

*This is not a complete list of hospital closures in IL

Mercy Hospital, Chicago, 2021

St Mary’s Hospital, Streator, 2015

St Elizabeth’s, Belleville, 2015

Kenneth Hall, East St Louis, 2011

Jackson Park Hospital, Chicago, 2019

MetroSouth, Blue Island, 2019

Franciscan, Chicago Heights, 2018

Silver Cross, Joliet, 2012

closed its labor & delivery unit

40% of patients on Medicaid

moved 5 miles west to wealthier Olympia Fields

moved 3 miles N to wealthier city New Lenox

moved 7 miles NE to wealthier city O’Fallon

served the uninsured

(4x more than the ntnl avg)

INFANT MORTALITY

PREVENTABLE MORTALITY

LIFE EXPECTANCY

32nd

26th

31st

U.S. Rankings:

The Ultimate Sacrifice:

Excess Deaths Due to Lack of Insurance

Excess deaths in 2022 totaled 34,527

Four more stops on the blue line and life expectancy plummets

-David Ansell

Months of Adult Black Lives Lost as Compared to Whites

Medical prevention and treatment would help 86% of the difference in life expectancy

African Americans ages 18-49 are 2x as likely to die from heart disease than Whites.

African Americans ages 35-64 years are 50% more likely to have high blood pressure than Whites.

The life expectancy of Black Americans is 4 years lower than White Americans

Black Men spend MORE on Health care than other groups

Non-Hispanic Black individuals experienced more than 2-fold

higher cumulative lifetime healthcare expenses compared with individuals of other racial and ethnic groups

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American Journal of Preventive Cardiology,Volume 14, 2023

How Did We Get Here?

Under slavery, healthcare was all about maximizing profits for slave owners

• Healthcare provided as a means to protect labor produced by the exploited body
• Terrible living conditions, malnutrition, and mistreatment led to poor health
• Enslaved families took care of themselves as they couldn't rely on slaveholders to provide access to doctors

Medical Racism in America Goes Back to Our Beginnings

Gordon, 1863

After Slavery Came...

poverty

lack of education

poor work conditions

increased incarceration

segregation

disease

Higher rates of poverty, illiteracy, and low baseline health lead to...

MEDICAL ABUSE

Black people were used for medical teaching & research without consent

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Medical Experimentation

Dr. Marion Sims

Tuskegee Experiment

• considered the "father of modern gynecology"
• practiced’ gynecological procedures on young black women, without consent & anesthesia
• performed 30 procedures on one woman alone

• 600 Black men signed up with the promise of free medical care
• Many were not told they had syphilis, only that they had “bad blood”
• As a result, many men unknowingly passed the disease to their wives and children
• The study continued for another 2.5 decades after 1947. PHS officials wanted to continue until all participants had died.

Forced Sterilization

Many states passed sterilization & eugenics laws in the early 1900s, which allowed physicians to sterilize people (without knowledge of consent) deemed unfit to reproduce

• Women deemed “promiscuous” or “feeble-minded”
• Men deemed “prone to crime”
• Targeted people of color

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MISSISSIPPI “APPENDECTOMIES”

60% of Black women in Sunflower County were sterilized without consent

NATIVE AMERICAN WOMEN

At least 24% of all Native American women sterilized in the 1970s

Hospitals: 1800s-1930s:

Hospitals were mostly private, non-profit

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• Different ethnic groups cared for their own “deserving poor”
• Irish Catholics had hospitals for Irish Catholics, Russian Jews had hospitals for Russian Jews
• Private hospitals had no restrictions, doctors could see – or not see – whoever they wanted
• The “non-deserving poor” (usually black people) were left to county facilities whose conditions were much worse

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Hospitals were mostly private, non-profit

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• Different ethnic groups cared for their own “deserving poor”
• Irish Catholics had hospitals for Irish Catholics, Russian Jews had hospitals for Russian Jews
• Private hospitals had no restrictions, doctors could see – or not see – whoever they wanted
• The “non-deserving poor” (usually black people) were left to county facilities whose conditions were much worse

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An ambivalence from white leaders on providing care

• Wanted formerly enslaved healthy enough to do labor
• But were fearful of a free and healthy black race
• Also worried about diseases spreading to their communities

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Hospitals: 1800s-1930s:

First federal healthcare program: Freedmen’s Bureau

• This program epitomized this ambivalence
• Deployed 120 doctors to the South & opened 40 hospitals
• The program didn’t listen to pleas for more personnel & equipment
• Most hospitals were quickly closed

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Hospitals were mostly private, non-profit

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• Different ethnic groups cared for their own “deserving poor”
• Irish Catholics had hospitals for Irish Catholics, Russian Jews had hospitals for Russian Jews
• Private hospitals had no restrictions, doctors could see – or not see – whoever they wanted
• The “non-deserving poor” (usually black people) were left to county facilities whose conditions were much worse

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An ambivalence from white leaders on providing care

• Wanted formerly enslaved healthy enough to do labor
• But were fearful of a free and healthy black race
• Also worried about diseases spreading to their communities

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Hospitals: 1800s-1930s:

Medical racism is the systematic and widespread racism against people of color within the medical system.

Racism in our society makes Black people less healthy

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Biases held by healthcare workers negatively affect the people of color in their care

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Disparities in health coverage by race make it more difficult for Black people to find care

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1930s & 1940s:

1930s

• Blue Cross started selling hospital & medical insurance
• Started as non-profit and mostly sold through employers
• Gov said employer money used for healthcare wouldn’t be taxed.

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• By 1950, 50% of the population had employer-sponsored coverage
• Black people were denied most jobs that offered employer coverage

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1930s & 1940s:

1940s

• National health insurance was very popular in the South in 1946.

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• Once it became associated with Civil Rights, the support for a national plan then plummeted.

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1930s

• Blue Cross started selling hospital & medical insurance
• Started as non-profit and mostly sold through employers
• Gov said employer money used for healthcare wouldn’t be taxed.

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• By 1950, 50% of the population had employer-sponsored coverage
• Black people were denied most jobs that offered employer coverage

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Passage of Medicare

1964

• Civil Rights Act passed

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• In order to receive federal funding, hospitals had to desegregate

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Passage of Medicare

1965

• The federal purse proved powerful….
• Thousands of hospitals desegregated in 1965

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• While employer- sponsored coverage flourished, the poor, elderly, and disabled were left out
• Medicare passed in 1965 to take care of the poor, elderly, and disabled

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1964

• Civil Rights Act passed

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• In order to receive federal funding, hospitals had to desegregate

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• Hospital coverage
• No premiums considered

mandatory insurance

Allowed doctors in the South to discriminate & refuse to care for black people

This provision was lobbied into the bill by the Democratic South

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Why is this significant?

Medicare Part A

Medicare Part B

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• Coverage for providers
• Requires premiums considered

voluntary insurance

Allowed states to establish discriminatory eligibility requirements & determine where benefits offices were located

This provision was lobbied into the bill by the Democratic South

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Why is this significant?

Medicare

Medicaid

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State administered

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Federally administered

• Many countries passed universal healthcare in the early 1900s.

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• We weren’t able to.

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Which leads to our current system...

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• Insurance companies realized they could make good money off people wanting health security
• 1994: Blue Cross allowed franchises to become for-profit

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In the meantime...

• Mix of private and public insurers.
• For-profit incentive in providing insurance and care.
• Significant healthcare inequities along income and racial lines.

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Our current system...

60% of those uninsured are people of color

Black maternal mortality 3x greater than white maternal mortality

Native Americans live 5.5 years less

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Why hasn’t the system changed?

Millions of Dollars Go Towards

Healthcare Lobbying Every Year

Spending of Leading Lobbying Industries in U.S., 2022

The healthcare industry as a whole spent over

$660 million

on lobbying in 2022

This is fear-mongering.

And it is unfounded.

• Immigrants currently pay far more for healthcare than they receive in both private AND public insurance.
• Whenever you create eligibility requirements, you create unnecessary administrative burden to determine eligibility.
• It costs more to exclude people, than to include them!

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Healthcare providers don’t want to determine who has documentation and who doesn’t.

They just want to provide care.

Single Payer for Healthcare Equity

How It Works

• Covers everyone, from birth to death
• Comprehensive coverage, including payments to medical,preventive, dental, vision, hearing, long-term care, prescriptions,mental health, reproductive care
• No cost-sharing (i.e. no co-payments, no premiums, no deductibles)
• Paid for by one national payer, but care still provided by private institutions

What is Single Payer?

Benefits of Single Payer (SP)

Lower healthcare costs!

More effective in negotiations

Government accountability

More equitable care

Healthcare not tied to employment

Better equipped to improve public health outcomes

Improve provider financial stability

No medical bankruptcies

Transparency

Lifts the burden from employers & local municipalities

Freedom to get care

• Give everyone the ability to access care, no matter their job, income, age, or marital status
• Eliminate the incentive of providers to cater to the wealthy
• Begin to equalize outcomes by providing equal access

What Can Single Payer Do?

• Improve all social determinants of health (housing, food access, safety, etc.)
• Eliminate racial bias in medicine

It can:

It can't:

Universal Healthcare Means

Racial Disparities Nearly Disappear

People of Color are more likely to be uninsured or underinsured than White people.

People of Color are more likely to die from preventable and treatable illnesses.

Fewer healthcare facilities; existing facilities are under-resourced and in danger of closing

Racism is embedded in our healthcare delivery system

How Can Single Payer Address Some Key Problems at the Intersection of Health and Race?

Medicare for All

Public option plans are not universal and may still leave millions without coverage.

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They do nothing to help people with expensive, low-quality private insurance that discourages the use of care.

Medicare for All provides comprehensive, life-long coverage for everyone, regardless of income, age, or employment.

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Patients get the care they need without premiums, copays, or deductibles.

Public Option

Many public option proposals require expensive copays and deductibles, which prevent patients from seeking timely care for health problems. A public option would do nothing to help those on high-cost, low-quality private or employer health plans that discourage care.

Medicare for All allows everyone to get the care they need when they need it, by providing lifelong coverage for all medically necessary care, including preventive and primary care, prenatal and maternal care, dental, mental health, prescriptions, and long-term care.

Medicare for All

Public Option

Medicare for All

Public Option

A public option leaves our fragmented health system in place.

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It provides no resources to research or combat racial bias in the funding and delivery of care.

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A publicly funded health system can invest in better research and data collection on racial inequity and provide training and education for health professionals to combat racial bias.

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Medicare for All

Public Option

The establishment of Medicare and Medicaid in 1965, in conjunction with the Civil Rights Act of 1964, was transformative in desegregating the nation’s health care system for patients and providers, and in improving access to care.

What could Medicare for All do to improve the racial health inequities of today?

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Thank You!

-The Illinois Single Payer Coalition

ilsinglepayer.org

info@ilsinglepayer.org

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